In diseases of peripheral vessels, the effectiveness of using drugs based on garlic, ginkgo biloba, omega-3 PUFA, Padma 28 (a mixture of herbs from 22 different ingredients) and vitamin E has been studied. Results of randomized controlled studies, systematic reviews and meta-analyzes indicate the effectiveness of ginkgo biloba compared with placebo in patients with intermittent claudication.
There is also evidence of the effectiveness of Padma 28, but they are few. It has been shown that in case of venous insufficiency, an extract of horse chestnut seed is effective.
a) Ginkgo biloba leaf extract. Ginkgo biloba (Ginkgo biloba) is used to treat intermittent claudication in patients with PAD. A review of research findings suggests that ginkgo biloba extract more effectively placebo reduces the symptoms of intermittent claudication (Peripheral Arterial Disease Fontaine study, stage II).
In clinical studies, doses of 120-160 mg / day were used and the walking distance without pain and the maximum walking distance were analyzed. Ginkgo biloba leaves and their extract contain several biologically active substances, including flavonoids, terpenoids and organic acids. The main active substances are bilobalide and ginkgolides.
As in the case of any herbal remedies, several components of the extract of ginkgo biloba can cause positive effects. Ginkgo biloba does not interact with cardiac glycosides while using these drugs. Thus, against the background of the use of ginkgo biloba, a small positive effect on BAP is found, possibly due to the destruction of free radicals, anti-platelet action, anti-inflammatory effects, vasodilation and a decrease in blood viscosity.
The usual dose is 40 mg of the standardized extract of ginkgo biloba 3 times a day. Ginkgo biloba is considered a relatively safe drug, rare adverse events include mild gastrointestinal dysfunction, nausea, dyspepsia and headache. Ginkgo biloba is noted to increase the risk of bleeding. One hundred concomitant use with aspirin, NSAIDs and anticoagulants such as warfarin and heparin is not recommended.
b) Horse chestnut. Horse chestnut extract (Aesculus hippocastanum) contains saponins, coumarins, flavonoids and tannins. The biological activity of the extract is associated with saponins (escin). A systematic review of 17 randomized placebo-controlled trials of this drug has recently been carried out.
In 6 studies (n = 543). in which the pain in the legs when walking was assessed, the decrease in the severity of this symptom was reliably established compared with placebo. In 4 of 5 studies (n = 420) in patients taking horse chestnut extract, there was a significant decrease in edema compared with placebo. Also, while taking horse chestnut extract, the circumference of the lower leg and ankle decreases.
One study noted the effectiveness of horse chestnut extract in combination with wearing elastic stockings. The effective dose of horse chestnut extract is standardized so that the patient receives 100-150 mg of escin per day. While taking a horse chestnut extract, symptoms such as itching, fatigue and apathy are reduced. Adverse events are rare, but gastrointestinal irritation, dizziness, nausea, headache and itching are possible. There are 2 cases of toxic nephropathy.
Contraindications include hypersensitivity to escin, as well as abnormal liver function or kidney function. Escine – the main horse chestnut extract saponin – binds to plasma proteins and can affect the binding of other drugs. There is an assumption about the possible hypoglycemic effects of horse chestnut extract. German Commission E approved the use of horse chestnut extract for venous insufficiency; horse chestnut products are also available on the US market.